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A Reform Synagogue Beyond Labels
No one can ever put us in a box, because we will always be a circle of friends.
MEMBERSHIP APPLICATION
Welcome to Beth Emet!
We are thrilled that you have decided to join, and we look forward to getting to know you. Beth Emet is a caring community, and we fervently encourage everyone to get involved in ways that feel meaningful to them. As such, we invite you to share a bit of yourself here. Financial information will remain confidential. Should you wish to discuss payment plans and/or anything that you feel is pertinent that you may not wish to disclose here, we invite you to be in touch with Bekki Harris Kaplan, Director of Congregational Engagement, by
email
or by calling 847-869-4230 ext. 304. Thank you!
Adult Applicant 1
Title
Please select...
Mr.
Ms
Mrs.
Dr.
Other
Full Name
Preferred Name
(Steve for Steven)
Gender
Please select...
Male
Female
Genderqueer/Non-Binary
Preferred Pronoun
Please select...
He / Him
She / Her
They / Them
Ze / Zir
Adult Applicant 2
Title
Please select...
Mr.
Ms.
Mrs.
Dr.
Other
Full Name
Preferred Name
(Steve for Steven)
Gender
Please select...
Male
Female
Genderqueer/Non-Binary
Preferred Pronoun
Please select...
He / Him
She / Her
They / Them
Ze / Zir
Personal Status
Single
Married
Life Partner
Engaged
Divorced
Widowed
Other
Anniversary Date
Hebrew Name
Birth date
How long have you lived in the area?
Religious Background in which you were raised
Please select...
Reform
Conservative
Orthodox
Secular
Reconstructionist
Traditional
Jewish by Choice
Not Jewish
Other
Other
Year of Conversion
Did your education include
Bar/Bat Mitzvah
Confirmation
Do you read Hebrew?
Please select...
Yes
No
Do you read/chant Torah?
Please select...
Yes
No
Current or most recent congregation
Hebrew Name
Birth date
How long have you lived in the area?
Religious Background in which you were raised
Please select...
Reform
Conservative
Orthodox
Secular
Reconstructionist
Traditional
Jewish by Choice
Not Jewish
Other
Other
Year of Conversion
Did your education include
Bar/Bat Mitzvah
Confirmation
Do you read Hebrew?
Please select...
Yes
No
Do you read/chant Torah?
Please select...
Yes
No
Current or most recent congregation
Contact Information
How would you like your formal name to appear (e.g. Bekki and Dan Kaplan)
How would you like your informal greeting to appear (e.g. Bekki and Dan)
Home Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Home Phone
Adult 1 Cell
Adult 2 Cell
Adult 1 Email
Adult 2 Email
Would you like to arrange a personal meeting with our Rabbi?
Please select...
Yes
No
May we publish your name, address, telephone number, and email address in the Beth Emet Membership online directory?
Please select...
Yes
No
Page 2
Business Information
Adult Applicant 1
Occupation/Profession
Specialty
(e.g. Cardiac surgeon, middle school teacher)
Employer
Business Phone
Adult Applicant 2
Occupation/Profession
Specialty
(e.g. Cardiac surgeon, middle school teacher)
Employer
Business Phone
Children's Information
Children 26-years-old and younger are included in your membership.
Do you have children under 26-years-old whom you would like included in your membership?
Please select...
Yes
No
If so, how many?
Please select...
1
2
3
4
5+
Child 1
Gender
Male
Female
Genderqueer/Non-Binary
First and Middle Name
Last Name
Nickname
Birth Date
Cell Phone Number
Email Address
Hebrew Name
Name of School
Grade in School
High School Grad Year
Are you interested in young family programming (ages 5 and younger)
Please select...
Are you interested in Beit Sefer (religious school)?
Please select...
Is your child interested in participating in any youth groups?
Please select...
Child 2
Gender
Male
Female
Genderqueer/Non-Binary
First and Middle Name
Last Name
Nickname
Birth Date
Cell Phone Number
Email Address
Hebrew Name
Name of School
Grade in School
High School Grad Year
Are you interested in the Early Childhood School?
Please select...
Are you interested in Beit Sefer (religious school)?
Please select...
Is your child interested in participating in any youth groups?
Please select...
Child 3
Gender
Male
Female
Genderqueer/Non-Binary
First and Middle Name
Last Name
Nickname
Birth Date
Cell Phone Number
Email Address
Hebrew Name
Name of School
Grade in School
High School Grad Year
Are you interested in the Early Childhood School?
Please select...
Are you interested in Beit Sefer (religious school)?
Please select...
Is your child interested in participating in any youth groups?
Please select...
Child 4
Gender
Male
Female
Genderqueer/Non-Binary
First and Middle Name
Last Name
Nickname
Birth Date
Cell Phone Number
Email Address
Hebrew Name
Name of School
Grade in School
High School Grad Year
Are you interested in the Early Childhood School?
Please select...
Are you interested in Beit Sefer (religious school)?
Please select...
Is your child interested in participating in any youth groups?
Please select...
Child 5
Gender
Male
Female
Genderqueer/Non-Binary
First and Middle Name
Last Name
Nickname
Birth Date
Cell Phone Number
Email Address
Hebrew Name
Name of School
Grade in School
High School Grad Year
Are you interested in the Early Childhood School?
Please select...
Are you interested in Beit Sefer (religious school)?
Please select...
Is your child interested in participating in any youth groups?
Please select...
Page 3
TELL US A BIT ABOUT YOURSELF:
So we may better accommodate your needs, please indicate physical limitations of members in your household. Please check all that apply.
Vision Impairment:
Adult 1
Adult 2
Child 1
Child 2
Child 3
Child 4
Child 5
Hearing Impairment:
Adult 1
Adult 2
Child 1
Child 2
Child 3
Child 4
Child 5
Mobility:
Adult 1
Adult 2
Child 1
Child 2
Child 3
Child 4
Child 5
What else should we know?
Adult 1
Adult 2
Child 1
Child 2
Child 3
Child 4
Child 5
Please Describe:
Referral Information
How did you hear about us?
Referred by
Website
Social Media
Jewish Publication
Live in neighborhood
Other
What most interests you about joining Beth Emet?
Friends and Relative Information
Please list any close friends or relatives who are members of the Beth Emet community and their relationship to you (i.e. Sarah Cohen/Steven's Cousin)
Name(s)/Relationship
Yahrzeit (Memorializing Loved Ones)
Name to be Remembered
Relation and to Whom
How to Observe:
Please select...
Secular Date
Hebrew Date
Date of Death (English or Hebrew)
Page 4
Finding Your Place at Beth Emet The Free Synagogue
So you've made the decision to join Beth Emet The Free Synagogue! Now what? Although we are a large congregation, we have a multitude of programs and comittees that will allow you to find a deep and personal connection within our community. Whether you are interested in meeting new people, continuing your Jewish education, volunteering your time at our soup kitchen, or discussing Jewish text in an informal setting, Beth Emet has a way in which you can become engaged and make a meaningful difference not only in the life of the community but for yours as well.
To help us better understand how you wish to get involved, what skills, hobbies, or interests (e.g. musical talents, public relations experience, involvement in social justice organizations) do you or members of your household have that might be shared with the congregation through our programming, religious school, adult education or worship?
Name
Name
Interests/talents (e.g. art, travel. opera)
Accounting / Finance
Archiving / Library
Arts
Baking / Cooking
Caring for Sick or Elderly
Communication / Social Media
CPR Training
Driving for Deliveries
Environmental Causes
Event Planning
Games (specify in other)
Gardening
Graphic Design
Group Facilitation
Interfaith Issues
Jewish Education
Knitting
Legal pro-bono work
LGBTQ Issues
Mindfulness
Movie
Music (Instruments)
Office Work
Photography
Purim Shpiel - Writing and/or Performing
Reading
Singing
Story Telling
Strategic Planning
Technology
Theater
Writing/Editing
Interests/talents (e.g. art, travel. opera)
Accounting / Finance
Archiving / Library
Arts
Baking / Cooking
Caring for Sick or Elderly
Communication / Social Media
CPR Training
Driving for Deliveries
Environmental Causes
Event Planning
Games (specify in other)
Gardening
Graphic Design
Group Facilitation
Interfaith Issues
Jewish Education
Knitting
Legal pro-bono work
LGBTQ Issues
Mindfulness
Movie
Music (Instruments)
Office Work
Photography
Purim Shpiel - Writing and/or Performing
Reading
Singing
Story Telling
Strategic Planning
Technology
Theater
Writing/Editing
Adult 1
Adult B'nai Mitzvah
Adult Education
Choir
College Outreach
Communications
Environment
Event Planning
Finance Committee
Fundraising
Garden
Inclusion (e.g. Jews of Color, Disabilities, LGBTQ+)
Interfaith
Israel
Membership
Music / Band
Racial Justice
Shabbat Connections (Shabbat Dinner)
Shiva Minyan Leader
Social Justice (Advocacy, Direct Service or Tzedekah)
Soup Kitchen
Technology
Teen Programming
Tzedekah Committee
Usher / Greeter
Young Family Programming
Adult 2
Adult B'nai Mitzvah
Adult Education
Choir
College Outreach
Communications
Environment
Event Planning
Finance Committee
Fundraising
Garden
Inclusion (e.g. Jews of Color, Disabilities, LGBTQ+)
Interfaith
Israel
Membership
Music / Band
Racial Justice
Shabbat Connections (Shabbat Dinner)
Shiva Minyan Leader
Social Justice (Advocacy, Direct Service or Tzedekah)
Soup Kitchen
Technology
Teen Programming
Tzedekah Committee
Usher / Greeter
Young Family Programming
Once we learn about your interests, we will place your name on our mailing list and someone will contact you regarding future projects, events and meetings. Watch for EmetMail, our bi-weekly eNewsletter and bi-annual Synagogue Bulletin, known as The
Chadashon
, to find out about upcoming programs.
Page 5
Membership Commitment
Our fiscal year begins on July 1 through June 30.
New Member Rate is a three year "ramp up:"
First year is $100 per month / $1,200 per year.
Second Year is as Follows:
Households with 2 adults over the age of 40 - $200 per month or $2,400 per year
Households with 1 adult over the age of 40 - $142 per month or $1,700 per year
Households with 2 adults over the age of 70 - $167 per month or $2,000 per year
Households with 1 adult over the age of 70 - $125 per month or $1,500 per year
Third year is full the full membership commitment. Contact the office for more information.
If you are
40 and younger* we have a "set your own membership commitment" program
whereby you can determine what feels most meaningful to you. The suggested amount is $100 per month ($1,200 per year) for the first year, and $150 per month ($1,800) for subsequent years (until the age of 40) if moving towards the full membership level is too much.
*
40 and younger is defined as the age of the oldest member of the household.
Please note that in keeping with Beth Emet's long standing policy of ensuring that every member can affiliate regardless of financial ability, please know that a confidential process is in place for those who require adjustment of the annual commitment. Should this apply to you and/or if you wish to make a payment arrangement, please contact our Director of Congregational Engagement, Bekki Harris Kaplan via
email
or by calling ext. 304
Building Reserve Fee:
Please note that all member households are billed a $175 building reserve fee, and for new members this begins in year 3. This fee supports capital improvements and serves as a "rainy day fund" to ensure that Beth Emet continues to maintain our building systems and able to respond responsibly when emergency repairs are needed.
Safety and Security Fee
: Please note that all member households are billed a $75 safety security fee, and for new members this begins in year 3. This fee ensures that we continue to responsibly address the ever-changing environment that requires improved security protocols and facility safety and security improvements.
How do you wish to receive monthly billing statements?
Please select...
By email (preferred)
By snail mail
Payment Cycle
Annual - paid in full
Semi-annual - due by Aug. 31 & Dec. 31
Monthly - due the end of each month, paid in full by June 30
Payment Information
My check payable to Beth Emet The Free Synagogue has been sent in the mail
I am signing up for automatic deduction payments via the
online form
. (Automatic deduction allows for monthly payments to be withdrawn from your checking account on the 15th of each month).
Please charge the following amount to my credit card (A 3% service fee will be added to any payments made with a credit card)
Payment Information
Total Charge Amount
Credit Card
Please select...
Visa
Master Card
Discover
American Express
Card Number
Name on card
Exp. Date mo/yr
CVV Code (from back of card)
Zip Code
Please use this box for any additional notes you would like to add:
Beth Emet The Free Synagogue ~ 1224 Dempster Street ~ Evanston, IL 60202 ~ 847-869-4230
Contact Information